Publications

Health systems are uniquely positioned to advance health equity in communities by ensuring that workers are well, resilient, and equipped to deliver high-quality care. The COVID-19 pandemic has shown how work environments in health systems affects the well-being of workers, whose capacity to deliver safe, patient- and family-centered care plays a central role in achieving health.

The aim of this project was to guide recommendations for future investments with the potential to identify health worker supports, strategies, and efforts to promote well-being, and to strengthen systems that ensure that they advance equity in health care and treat patients as people.

We conducted a scan of peer-reviewed and grey literature and interviewed a diverse set of national stakeholders committed to and responsible for addressing health worker well-being. The literature scan confirmed the need to prioritize multi-pronged organizational interventions over individual interventions to achieve systems change supporting worker wellness. Conversations with stakeholders underscored that the broader context in which health workers live and work affects their health and well-being. The effects on work and work climate of the COVID-19 pandemic, unmet social needs, recent social movements around racism, and larger policy issues around payment, reimbursement, and wages were emphasized as particularly profound.

The pandemic’s disproportionate effect on middle skill workers highlights differences in the nature of their work as well as differential access to skills, training, and social supports. These differences point to gaps in our knowledge of the factors that affect well-being for middle skill workers; this understanding is essential for designing effective interventions. The gaps highlight areas that would benefit from investment and strategies to prevent and ease burnout, improve diversity, and inform how to better promote progress toward health equity for a diverse workforce.

The greatest immediate need for improving health workers’ well-being is mental health supports to address increases in depression, anxiety, and stress. Acknowledging that there are important policy (e.g., payment reform) and cultural (e.g., reducing stigma) issues that must be addressed, but which exceed the initial scope of this effort, we identified five priority recommendations to pursue:

• Strengthen and expand resources to address mental health challenges. The pandemic has magnified mental health challenges for health workers and those on the frontlines, especially in acute care hospitals, have faced sustained daily exposure to suffering and death. The need for immediate and longer-term support includes increased access to counseling, as well as tools and coping resources. Access to culturally- and linguistically-diverse services is especially needed.
• Address secondary trauma experienced by health workers. Many health workers experience secondary trauma in their work. The pandemic has added further burdens, such as increased workloads, risk of job loss, and the pressures of dependent care without adequate support structures and services. Secondary trauma is known to be preventable and treatable, but the field is at a nascent stage with few examples of well-evaluated programs or services for addressing secondary trauma in health workers.
• Support development of comprehensive organizational approaches to improve worker well-being. The COVID-19 pandemic has emphasized the need for organizations to change or reexamine structures, workflows, and policies that contribute to burnout or a culture of suffering in silence. Given the unique role of safety net organizations in employing diverse workers who are racially, culturally and linguistically concordant with communities they serve, there is an opportunity to further health equity goals by ensuring that safety net organizations have resources and tools to address worker well-being.
• Grow the knowledge base and tools for improving health worker well-being. Most well-being efforts to date have focused on clinicians, especially physicians and nurses. There is potential to substantially further health equity by investing in the large and often overlooked middle skill workforce (e.g., food and nutrition services, environmental services), to understand their unique needs and vulnerabilities, and to test solutions for improving their well-being. 
• Reduce stigma for health care workers seeking mental health services and supports. Many health workers are reluctant to seek assistance with mental health issues due to concerns around potential stigma, as well as worries about licensing policies and confidentiality. Opportunities to support advocacy to reduce mental health disorder stigma will have significant impact for those looking to access and use resources.

High-quality health care depends on a resilient and well workforce. The pandemic has spurred organizations to recognize the urgent need to improve health worker well-being. It is vital to creatively invest in increasing knowledge, testing solutions, and sharing learning to create systems that treat patients as people and build incentives for advancing equity in health care. No health care system should have to decide if they will care for the individuals that make up their workforce or meet the health needs and goals of communities they serve. Health care systems must be equipped to invest in the wellness of their workers, which in turn will enable them to best meet the needs and goals of the communities they serve for now and for generations to come.